Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

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Brain monoaminergic activity in rainbow trout selected for high and low stress responsiveness

This paper investigates whether two lines of rainbow trout displaying genetically determined variation in stress responsiveness and behavior also show differences in brain monoaminergic activity. In several brain regions, strains of rainbow trout selected for consistently high or low post-stress cortisol levels displayed differences in tissue concentrations of monoamines and/or monoamine metabolites, or in metabolite/monoamine ratios. High-responsive trout reacted to stress by an increase in the concentrations of both serotonin (brain stem), dopamine (brain stem), and norepinephrine (optic tectum, telencephalon), whereas low-responsive fish did not. Brain stem and optic tectum concentrations of monoamine metabolites were also elevated after stress in high responders, but not in low-responsive fish. The simultaneous increase in the concentration of monoamines and their metabolites suggests that both synthesis and metabolism of these transmitters were elevated after stress in high-responsive trout. A divergent pattern was seen in the hypothalamus, where low-responsive fish displayed elevated levels of 5-hydroxyindoleacetic acid (a serotonin metabolite) and 3-methoxy-4-hydroxyphenylglycol (a norepinephrine metabolite). In the telencephalon, both populations had elevated concentrations of these metabolites after stress. These results clearly suggest that selection for stress responsiveness in rainbow trout is also associated with changes in the function of brain monoaminergic systems. The possible functional significance of these observations is discussed with respect to the physiological and behavioral profile of these strains of fish. Literature is reviewed showing that several factors affecting brain monoaminergic activity might be altered by selection for stress responsiveness, or alternatively be under direct influence of circulating glucocorticoids

Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention

Objective: We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term. Methods: In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI. Results: From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics. Conclusions: Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar

Assessment of the physiological impact of endocrine disrupting chemicals on salmonid fish from selected sites in Scotland and Northern Ireland

1. Recent research in the UK and elsewhere has demonstrated that industrial and domestic effluents may contain compounds of both natural and synthetic origin which are steroid estrogens, or mimic the activity of steroid estrogens. Although present in solution at very low concentrations the sensitivity of the endocrine system of animals to interference is such that these contaminants represent a potentially disruptive threat. 2. A survey of gonadal structure in roach populations in English rivers revealed that a high proportion (25% – 60%) of male fish within the sampled populations displayed evidence of abnormal gonadal development in the form of ovarian tissue within the testes. These effects were most pronounced at sites where discharged effluents represented a high proportion of total flow in the river. The functional significance of these observations has yet to be established. 3. Concerns have been raised regarding the possible susceptibility of valuable salmon and trout populations to endocrine disruptive processes. This report describes the results of a fieldbased investigation of indicators of estrogen exposure in salmonid fish exposed to potentially estrogenic effluent discharges at sites in Scotland and Northern Ireland. 4. This study addressed the possibility that native salmonid populations are being exposed to estrogenic contaminants via both domestic and industrial discharges and that this exposure may result in inappropriate and possibly detrimental physiological effects in exposed fish. 5. This objective was addressed by the sampling of brown trout and Atlantic salmon from sites receiving a STW discharge and from pristine sites. Blood levels of the estrogen-inducible yolk precursor vitellogenin were measured to assess whether there was evidence that the targeted populations were exposed to acute estrogen exposure. In addition, gonadal material sampled from each fish was examined microscopically for evidence of abnormal reproductive development, the presence of which would be indicative of early or possibly chronic exposure to estrogens. 6. A total of 209 fish were examined from four sites in Scotland [R. Teviot, Slitrig Water (tributary of the R. Teviot), Wilson Burn and Ale Water (pristine sites)]. Fish sampled from the R. Teviot were removed downstream of the Hawick STW discharge. In all the fish which were sampled blood vitellogenin levels were low, displaying no evidence of environmental estrogen-induced elevation. The gonadal structure of all the sampled fish was normal, with no evidence of ovarian tissue in male testes and no evidence of unusual ovarian development in female fish. 7. A total of 64 fish were examined from three sites in Northern Ireland (Minnowburn, Collin River and Ravernet River; all tributaries of the R. Lagan). As was the case for the Scottish sites, no evidence of gonadal abnormalities was obtained in fish from any site. 8. In addition to the field sampling, the estrogenicity of the effluents discharged at each site were evaluated by bioassay. In Northern Ireland, rainbow trout were held in cages submerged in the vicinity of the New Holland Sewage Treatment Works (STW) effluent discharge (R. Lagan). An aquarium-based exposure of rainbow trout to Hawick STW (R. Teviot) final effluent, at concentrations up to 100%, was employed. Analysis of blood vitellogenin levels after a period of or 11 – 14 days exposure in aquaria revealed that the Hawick STW effluent was not estrogenic. However, fish exposed to New Holland STW final effluent in situ for 3 weeks displayed elevated blood vitellogenin levels, relative to fish caged at control sites, indicating that the effluent contained estrogenic components. 9. Water samples collected from both study sites were analysed for total alkylphenols and alkylphenol ethoxylates (APEs; ubiquitous environmental contaminants and known estrogen mimics found in high concentrations in English rivers with a high incidence of intersexuality). Samples from the Hawick sites contained very low levels of APEs (< 3 :g l-1). Similar levels were found in samples from the sites in Northern Ireland with the exception of effluent samples taken downstream of the Barbour Campbell Linen Mill which contained 12 :g l-1 total APEs. Steroids were not quantified in these samples. 10. The microscopic examination of gonad structure, and analysis of blood vitellogenin levels, indicated that there was no evidence of exposure to estrogenic contaminants in the salmonid fish populations of the R. Teviot or R. Lagan. 11. A number of factors probably contribute to this result. Salmonid fish exhibit a life-history very different to that of cyprinid fish such as roach in which effluent-related intersexuality has been reported. Trout and salmon normally spawn in clean gravel beds in the upper reaches of a river system and newly-hatched and early juvenile salmonid fish remain in these relatively pristine stretches of river. They are therefore not usually exposed to point-source effluent discharges during critical early developmental stages when the reproductive system is particularly sensitive to external influences. In addition, both salmon and migratory brown trout (sea trout) are anadromous fish, spending a significant proportion of their lives at sea. These factors contrast with the potential for life-long exposure to contaminants displayed by non-migratory cyprinid fish which spawn in the main body of the river. Additionally, salmonid fish are less tolerant of poor water quality than cyprinid fish and even the nonmigratory brown trout are therefore not normally present in rivers subject to high effluent input. Most rivers which support populations of salmonid fish do not pass through heavily populated or industrialised areas. There is therefore less likelihood that these fish populations will encounter high concentrations of endocrine disrupting chemicals (EDCs). 12. Overall, these data do not provide absolute reassurance that salmonid fish are unaffected by estrogens and estrogen mimics present in effluent discharges but they do indicate that if a problem does exist it may be localised and on a smaller scale than has been reported for cyprinid fish. 13. Consideration should be given to a more widespread survey of gonad structure in salmonid fish populations in order to confirm these preliminary conclusions. It should also be considered whether reproductive performance of salmonid fish might be influenced by exposure to EDCs via mechanisms which do not involve alterations in gonadal structure (e.g. alterations in fecundity, gamete quality, behavioural changes). In addition, the possibility that aspects of the salmonid life-history other than reproductive development may be affected by EDCs should be examined. 14. For example, smoltification (pre-migratory sea water adaptation) is a critically important aspect of the salmonid life history. Smoltification is closely regulated by the endocrine system and may be susceptible to interference by chemicals which mimic or interfere with the activity of hormones other than estrogens. 15. It should also be considered whether sources of contamination other than effluent discharges (e.g. agricultural run-off) may expose salmonid fish to endocrine-disrupting chemicals

Microvascular resistance predicts myocardial salvage and infarct characteristics in ST-elevation myocardial infarction

&lt;b&gt;Background:&lt;/b&gt; The pathophysiology of myocardial injury and repair in patients with ST‐elevation myocardial infarction is incompletely understood. We investigated the relationships among culprit artery microvascular resistance, myocardial salvage, and ventricular function.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods and Results:&lt;/b&gt; The index of microvascular resistance (IMR) was measured by means of a pressure‐ and temperature‐sensitive coronary guidewire in 108 patients with ST‐elevation myocardial infarction (83% male) at the end of primary percutaneous coronary intervention. Paired cardiac MRI (cardiac magnetic resonance) scans were performed early (2 days; n=108) and late (3 months; n=96) after myocardial infarction. T2‐weighted‐ and late gadolinium–enhanced cardiac magnetic resonance delineated the ischemic area at risk and infarct size, respectively. Myocardial salvage was calculated by subtracting infarct size from area at risk. Univariable and multivariable models were constructed to determine the impact of IMR on cardiac magnetic resonance–derived surrogate outcomes. The median (interquartile range) IMR was 28 (17–42) mm Hg/s. The median (interquartile range) area at risk was 32% (24%–41%) of left ventricular mass, and the myocardial salvage index was 21% (11%–43%). IMR was a significant multivariable predictor of early myocardial salvage, with a multiplicative effect of 0.87 (95% confidence interval 0.82 to 0.92) per 20% increase in IMR; P&#60;0.001. In patients with anterior myocardial infarction, IMR was a multivariable predictor of early and late myocardial salvage, with multiplicative effects of 0.82 (95% confidence interval 0.75 to 0.90; P&#60;0.001) and 0.92 (95% confidence interval 0.88 to 0.96; P&#60;0.001), respectively. IMR also predicted the presence and extent of microvascular obstruction and myocardial hemorrhage.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Microvascular resistance measured during primary percutaneous coronary intervention significantly predicts myocardial salvage, infarct characteristics, and left ventricular ejection fraction in patients with ST‐elevation myocardial infarction.&lt;p&gt;&lt;/p&gt

Removing Orbital Debris with Lasers

Orbital debris in low Earth orbit (LEO) are now sufficiently dense that the use of LEO space is threatened by runaway collisional cascading. A problem predicted more than thirty years ago, the threat from debris larger than about 1 cm demands serious attention. A promising proposed solution uses a high power pulsed laser system on the Earth to make plasma jets on the objects, slowing them slightly, and causing them to re-enter and burn up in the atmosphere. In this paper, we reassess this approach in light of recent advances in low-cost, light-weight modular design for large mirrors, calculations of laser-induced orbit changes and in design of repetitive, multi-kilojoule lasers, that build on inertial fusion research. These advances now suggest that laser orbital debris removal (LODR) is the most cost-effective way to mitigate the debris problem. No other solutions have been proposed that address the whole problem of large and small debris. A LODR system will have multiple uses beyond debris removal. International cooperation will be essential for building and operating such a system.Comment: 37 pages, 15 figures, in preparation for submission to Advances in Space Researc

Effect of continuous nutrient enrichment on microalgae colonizing hard substrates

In order to understand the effect of changing nutrient conditions on benthic microalgae on hard substrates, in-situ experiments with artificial substrates were conducted in Kiel Fjord, Western Baltic Sea. As an extension of previous investigations, we used artificial substrates without silicate and thus were able to supply nutrient media with different Si:N ratios to porous substrates, from where they trickled out continuously. The biofilm developing on these substrates showed a significant increase in biovolume due to N + P enrichment, while Si alone had only minor effects. The stoichiometric composition of the biomass indicated nitrogen limitation during most of the year. The C:N ratios were lowered by the N + P addition. The algae were dominated by diatoms in most cases, but rhodophytes and chlorophytes also became important. The nutrient treatment affected the taxonomic composition mostly at the species level. The significance of the results with regard to coastal eutrophication is discussed

INNOVATIVE APPROACHES TO IMPROVING THE IMAGE OF PSYCHIATRISTS AND PSYCHIATRY AMONGST MEDICAL STUDENTS AND DOCTORS IN THE UK

In this paper we identify some of the critical factors that contribute to the ongoing shortage of psychiatrists in the UK. We discuss initiatives that have been launched to try and encourage more medical students and trainee doctors to choose psychiatry as a career. We describe the innovative anti-stigma Wounded Healer programme that was pioneered in the UK with the aim of improving the image of psychiatry and psychiatrists and that was subsequently scaled up and rolled out to over 65,000 medical students and doctors in 14 countries in five continents worldwide. We conclude, with some suggestions that we believe will help recruitment efforts into psychiatry

Color-accurate underwater imaging using perceptual adaptive illumination

Capturing color in water is challenging due to the heavy non-uniform attenuation of light in water across the visible spectrum, which results in dramatic hue shifts toward blue. Yet observing color in water is important for monitoring and surveillance as well as marine biology studies related to species identification, individual and group behavior, and ecosystem health and activity monitoring. Underwater robots are equipped with motor control for large scale transects but they lack sensors that enable capturing color-accurate underwater images. We present a method for color-accurate imaging in water called perceptual adaptive illumination. This method dynamically mixes the illumination of an object in a distance-dependent way using a controllable multi-color light source. The color mix compensates correctly for color loss and results in an image whose color composition is equivalent to rendering the object in air. Experiments were conducted with a color palette in the pool and at three different coral reefs sites, and with an underwater robot collecting image data with the new sensor.United States. Office of Naval Research (Project N000140911051

INNOVATIVE APPROACHES TO IMPROVING THE IMAGE OF PSYCHIATRISTS AND PSYCHIATRY AMONGST MEDICAL STUDENTS AND DOCTORS IN THE UK

In this paper we identify some of the critical factors that contribute to the ongoing shortage of psychiatrists in the UK. We discuss initiatives that have been launched to try and encourage more medical students and trainee doctors to choose psychiatry as a career. We describe the innovative anti-stigma Wounded Healer programme that was pioneered in the UK with the aim of improving the image of psychiatry and psychiatrists and that was subsequently scaled up and rolled out to over 65,000 medical students and doctors in 14 countries in five continents worldwide. We conclude, with some suggestions that we believe will help recruitment efforts into psychiatry